Provider Demographics
NPI:1710769047
Name:PENNY, ERICA DRISCOLL (NCLCMHCA)
Entity Type:Individual
Prefix:MRS
First Name:ERICA
Middle Name:DRISCOLL
Last Name:PENNY
Suffix:
Gender:F
Credentials:NCLCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 PEMBERTON HILL RD STE 202
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502-4266
Mailing Address - Country:US
Mailing Address - Phone:984-256-8754
Mailing Address - Fax:
Practice Address - Street 1:1011 PEMBERTON HILL RD STE 202
Practice Address - Street 2:
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502-4266
Practice Address - Country:US
Practice Address - Phone:984-256-8754
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-20
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC704161101YS0200X
NCA19271101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool